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Global perspective on acute coronary syndrome: a burden on the young and poor
Rajesh Vedanthan1, Benjamin Seligman1, Valentin Fuster2
1From the Department of Medicine, Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY (R.V., V.F.); Department of Biology and School of Medicine, Stanford University, Palo Alto, CA (B.S.); and Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.).
Insights
Ischemic heart disease (IHD) and acute coronary syndrome (ACS) disproportionately affect low- and middle-income countries (LMICs), often striking at younger ages. Addressing global IHD and ACS requires overcoming implementation challenges in LMICs through policy and coordinated efforts.
Area of Science:
- Cardiovascular Medicine
- Global Health
- Public Health Policy
Background:
- Ischemic heart disease (IHD) is the leading cause of global mortality and disability.
- Low- and middle-income countries (LMICs) bear a substantial burden, with younger age-of-death and higher impact on the poor.
- Acute coronary syndrome (ACS) data in LMICs are growing, filling previous research gaps.
Purpose of the Study:
- To highlight the significant global burden of IHD and ACS, particularly in LMICs.
- To identify challenges in implementing preventive and treatment strategies in LMICs.
- To emphasize the need for intersectoral policies and global coordination for disease control.
Main Methods:
- Review of existing literature on IHD and ACS in LMICs.
- Analysis of risk factors, prevention, and treatment strategies.
- Examination of implementation challenges and policy requirements.
Main Results:
- IHD and ACS impact LMICs more severely, affecting younger populations and the poor.
- While prevention and treatment tools exist, their implementation in LMICs faces significant hurdles.
- Successful health promotion, clinical care, and policy efforts require scaling and global coordination.
Conclusions:
- Effective control of IHD and ACS globally necessitates addressing implementation gaps in LMICs.
- Intersectoral policy initiatives and global coordination are critical for reducing the burden of these diseases.
- Scaling successful interventions is essential to manage the worldwide impact of ACS and IHD.
Abstract:
Ischemic heart disease (IHD) is the greatest single cause of mortality and loss of disability-adjusted life years worldwide, and a substantial portion of this burden falls on low- and middle-income countries (LMICs). Deaths from IHD and acute coronary syndrome (ACS) occur, on average, at younger ages in LMICs than in high-income countries, often at economically productive ages, and likewise frequently affect the poor within LMICs. Although data about ACS in LMICs are limited, there is a growing literature in this area and the research gaps are being steadily filled. In high-income countries, decades of investigation into the risk factors for ACS and development of behavioral programs, medications, interventional procedures, and guidelines have provided us with the tools to prevent and treat events. Although similar tools can be, and in fact have been, implemented in many LMICs, challenges remain in the development and implementation of cardiovascular health promotion activities across the entire life course, as well as in access to treatment for ACS and IHD. Intersectoral policy initiatives and global coordination are critical elements of ACS and IHD control strategies. Addressing the hurdles and scaling successful health promotion, clinical and policy efforts in LMICs are necessary to adequately address the global burden of ACS and IHD.
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